Abstract
Traditional therapy for giant gastric ulcers (greater than 3 cm) has been gastric resection because of a presumed high risk of hemorrhage and recurrence. To determine the validity of this approach and decide whether the need for resection has been altered by the introduction of H2-blockers, the records of 10,054 gastroduodenal endoscopies performed between 1971 and 1984 were reviewed. Forty-nine patients with giant gastric ulcers were identified. Five patients had malignant ulcers. Ten patients underwent gastric resection as initial therapy. Thirty-four patients were initially treated without surgery and were divided into Group I (no H2-blockers; 9 patients) and Group II (H2-blockers; 25 patients). Medical therapy was successful in three of nine patients (33%) in Group I and in 20 of 25 patients (80%) in Group II. Of 11 patients who failed medical therapy (7 intractability, 3 recurrence, and 1 fatal hemorrhage), 10 underwent subsequent gastric resection. Of the 20 patients treated surgically (10 initial and 10 medical failures), none were readmitted for recurrent ulcer disease. These data suggest that medical therapy of benign giant gastric ulcers is often effective and not associated with an excessive incidence of complications, as believed. Successful healing of these ulcers is greatly enhanced when H2-blockers are employed. Thus, the presence of an uncomplicated benign giant gastric ulcer is not an absolute indication for gastric resection.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Borgström B., Lundh G., Hofmann A. The site of absorption of conjugated bile salts in man. Gastroenterology. 1968 Apr;54(4 Suppl):781–783. [PubMed] [Google Scholar]
- COHN I., Jr, SARTIN J. Giant gastric ulcers. Ann Surg. 1958 May;147(5):749–759. doi: 10.1097/00000658-195805000-00020. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Englert E., Jr, Freston J. W., Graham D. Y., Finkelstein W., Kruss D. M., Priest R. J., Raskin J. B., Rhodes J. B., Rogers A. I., Wenger J. Cimetidine, antacid, and hospitalization in the treatment of benign gastric ulcer: a multicenter double blind study. Gastroenterology. 1978 Feb;74(2 Pt 2):416–425. [PubMed] [Google Scholar]
- FERRIS D. O. Gastric cancer. J La State Med Soc. 1953 Jun;105(6):211–216. [PubMed] [Google Scholar]
- Haddad W., Kestenbaum D. J., Wang H. S. Effect of cimetidine on healing and surgical treatment of gastric ulcers. Am J Surg. 1985 May;149(5):665–667. doi: 10.1016/s0002-9610(85)80151-3. [DOI] [PubMed] [Google Scholar]
- JONES F. A. Clinical and social problems of peptic ulcer. Br Med J. 1957 Apr 6;1(5022):786–793. doi: 10.1136/bmj.1.5022.786. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kukral J. C. Gastric ulcer: an appraisal. Surgery. 1968 Jun;63(6):1024–1036. [PubMed] [Google Scholar]
- LUMSDEN K. The problem of the giant gastric ulcer. Gastroenterologia. 1950;76(2):89–93. doi: 10.1159/000199136. [DOI] [PubMed] [Google Scholar]
- LoIudice T. A., Saleem T., Lang J. A. Cimetidine in the treatment of gastric ulcer induced by steroidal and nonsteroidal anti-inflammatory agents. Am J Gastroenterol. 1981 Feb;75(2):104–110. [PubMed] [Google Scholar]
- Lulu D. J. Benign giant gastric ulcer. Am Surg. 1971 Jun;37(6):357–362. [PubMed] [Google Scholar]
- SMITH F. H., BOLES R. S., Jr, JORDAN S. M. Problem of the gastric ulcer reviewed: study of one thousand cases. J Am Med Assoc. 1953 Dec 26;153(17):1505–1508. doi: 10.1001/jama.1953.02940340007003. [DOI] [PubMed] [Google Scholar]
- ZOLLINGER R. M., WATMAN R. N., DENKEWALTER F. Should all gastric ulcers be treated surgically. Gastroenterology. 1958 Nov;35(5):521–527. [PubMed] [Google Scholar]